CMS wants tighter oversight for Medicare prescriptions

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The Centers for Medicare & Medicaid Services has seen enough and wants to gain more control over drug-prescribing practices for the Medicare Part D program.

The agency has issued a proposed rule that would give officials more power to regulate the issuance of drugs, including at nursing homes.

The new proposal squarely takes aim at prescribers. Among other things, it dictates that they would have to be fully certified by Medicare to have their prescriptions covered under Part D.

CMS officials explained that certification would help ensure that only “qualified individuals” are prescribing under Part D. They would be able to revoke Medicare certification of any prescribers found to abuse the system.

In the past, CMS has put responsibility for overseeing the Part D program largely on the shoulders of private health plans that administer it. The new proposal would shift responsibilities, which should boost efforts to fight fraud and abuse, agency officials noted. Under the proposal, they would be able to obtain prescription records, invoices and other items directly from pharmacies, rather than through Part D plan sponsors.

The tighter prescribing proposals are part of a 678-page rule that addresses a variety of changes for Part D and Medicare Advantage. It appeared in the Federal Register on Jan. 10.

CMS has hardened its stand on prescribers partly in response to abuses uncovered by the media. Investigative journalism group ProPublica, for example, published a major report in early 2013 that highlighted psychiatrist Enrique Casuso, M.D. He was the top antipsychotics prescriber under Medicare, even though the state of Florida had removed him from its Medicaid program in 2005.